<#include "/client/config.ftl"/>
<!DOCTYPE html>
<html>
	<head>
		<meta charset="utf-8">
		<meta name="viewport" content="width=device-width, initial-scale=1,maximum-scale=1, user-scalable=no">
		<title>耐受性评估</title>
		<link rel="stylesheet" href="${base}/css/bootstrap.min.css" />
		<link rel="stylesheet" href="${base}/css/common.css" />
	</head>
	<body>
		<div class="container-fluid">
		<form action="${base}/client/task/judgeInfo" method="post">
			<ul class="judge_info">
				<li>
					<lable>羟考酮缓释片</lable>
					<span>
						<p>一日</p><input class="form-control" type="number" name="nums" />次<br>
						<p>一次</p><input class="form-control" type="number" name="amounts"/>mg<br>
						<p>已服用</p><input class="form-control" type="number" name="days" />天
					</span>
				</li>
				<li>
					<lable>吗啡即释片</lable>
					<span>
						<p>一日</p><input class="form-control" type="number" name="nums" />次<br>
						<p>一次</p><input class="form-control" type="number" name="amounts"/>mg<br>
						<p>已服用</p><input class="form-control" type="number" name="days" />天
					</span>
				</li>
				<li>
					<lable>是否带有吗啡</lable>
					<span>
						<input type="radio" name="haveMarfei" value="2" checked />是 
						<input type="radio" name="haveMarfei" value="1" />否
					</span>
				</li>
				<li>
					<lable>是否带有羟考酮</lable>
					<span>
						<input type="radio" name="haveAos" value="2" checked />是 
						<input type="radio" name="haveAos" value="1" />否
					</span>
				</li>
			</ul>
			<div class="hidden_area">
				<input type="hidden" value="${groupId}" name="groupId"/>
			</div>
			<div class="form-group login_reg_btn mar_top">
				<button type="submit" class="btn btn-primary">确认</button> 
			</div>
			</form>
		</div>
	</body>
</html>